University Hospital Southampton NHS Foundation Trust

Congenital diaphragmatic hernia

The diaphragm is the sheet of muscle that separates the chest from the abdomen. Diaphragmatic hernia (CDH) is a hole in the diaphragm and may be from one inch to several inches across. This results in the intestines (and sometimes the stomach) entering the chest cavity preventing lung growth. It usually occurs on the left side of the chest.

The cause of CDH is unknown. It is a rare condition and occurs in about 1 in 2000 babies and happens at about the third month of pregnancy.

Antenatal diagnosis

If detected before birth, CDH is diagnosed by seeing the stomach and some of the intestines in the chest area on the ultrasound scan. CDH can be associated with other abnormalities. Therefore it is important to carry out other investigations such as amniocentesis and a detailed scan of the heart.

CDH can also result in an increase in the amniotic fluid around the baby (known as polyhydramnios) which may lead to an early delivery. It is a serious condition. Overall 85% of those diagnosed antenatally may die before or after delivery, but of those with no other abnormalities approximately 50% survive.

What happens at the delivery?

It should be possible for you to deliver your baby in the normal way unless there are other reasons for requiring a Caesarean section. We would recommend, however, that delivery be at the Princess Anne Hospital. Your baby will be transferred to the Neonatal Unit soon after delivery.

Most babies have breathing difficulties at birth and will require immediate support for this. In severe cases, this may not be successful and the baby may die within hours. Surgery will usually be delayed until there are signs that the baby's lungs are strong enough. This may take 2 - 3 weeks. During this time the baby will be receiving intensive care. This will be supervised by the consultant neonatologists .

Your baby will also be under the care of one of our surgeons.  Other doctors will also be involved with your baby's care and will be introduced to you at the time.

Surgery

The surgery is carried out through an incision on the abdomen. The gut (intestines etc) is pulled down from the chest cavity and the diaphragm repaired. If the hole in the diaphragm is large, there may be a need to use an artificial patch to repair it.

The baby will still require help with breathing after surgery, so intensive care will continue. This may be needed for several weeks.

Can I feed my baby?

Most babies will require a period where they are fed by a drip inserted into a vein. Once recovered, most babies should be able to feed normally, either by bottle or breast-feed.

What are the long term effects and after care?

There may be no long-term effects at all. However, these babies can grow up suffering from chronic lung problems in early childhood. This can result in repeated hospital admissions with respiratory infections. These babies can also have feeding problems. The lungs can continue to mature up to 8 years of age.

Most survivors will be able to attend school normally and have a good quality of life. Many will be entirely normal older children and adults. Following discharge from the ward, there will be regular check-ups in order to monitor your baby's progress. An appointment for the paediatric outpatient department will be sent to you.

Disclaimer

University Hospital Southampton NHS Foundation Trust produce guidelines as an aid to good clinical practice. They represent recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented by the patient and the diagnostic or treatment options available. The guidelines issued are not intended to be prescriptive directions defining a single course of management and departure from the local guidelines should be fully documented in the patient's case notes at the time the relevant decision is taken.

External links